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State-Led Effort Helps Improve Blood Pressure Control Among Low-Income Patients


California faces a big challenge in controlling the blood pressure of low-income residents with hypertension, but a state-led program has shown some signs of progress.

Nine of the state’s 23 Medicaid managed care plans spent a year working with state officials, studying the latest blood pressure control methods, consulting with experts and sharing their own successes and failures. The results: The rate of hypertensive patients who managed to stabilize their blood pressure increased on average about five percentage points — from 56 percent in 2014 to 61 percent in 2015, according to a recent report by the Centers for Disease Control and Prevention.

That may not sound like a lot, but if sustained over time it could mean many fewer heart attacks and strokes.

Some of the plans registered even greater improvement. Alameda Alliance for Health of Alameda, Calif., increased the proportion of patients with controlled pressure from 43 percent to nearly 58 percent. Partnership HealthPlan of California, which serves 14 Northern California counties, saw a jump from 52 percent to 63 percent.

Overall, seven of the nine health plans that took part in the program showed improvement in controlling high blood pressure among their hypertension patients. The nine participating plans cover about 60 percent of the more than 400,000 Medi-Cal members who have been diagnosed with high blood pressure.

The state Department of Health Care Services invited those plans to participate in the program after determining that they had not met the federal goal for controlling blood pressure in 2014. Several of the plans were far below it.

“Hypertension is something we thought we could move the needle on if we worked together,” said Neal D. Kohatsu, medical director for the department.

Despite the recent progress, all but one of the health plans that joined the state effort had not hit the federal benchmark for 70 percent of hypertension patients to have their blood pressure under control. That benchmark is part of the Million Hearts initiative, a nationwide push by the CDC and the Centers for Medicare and Medicaid Services to prevent one million heart attacks and strokes by 2017.

High blood pressure is a significant risk factor for both heart attacks and strokes, yet only half of people with hypertension nationwide have it under control. Poor adherence to medication, an unhealthy diet and physical inactivity can all contribute to uncontrolled high blood pressure.

In the California effort, the health plans participated in regular webinars throughout 2015 and received information on evidence-based methods for improving blood pressure control among their members. The Million Hearts initiative describes several protocols for controlling blood pressure, including one by the Department of Veterans Affairs that recommends specific drugs, lab tests and strategies to improve medication adherence.

State officials couldn’t determine whether the webinars and the collaboration among health plans and the state caused the improvement, but Kohatsu said he had no doubt that sharing success stories and getting guidance from experts in the field were crucial.

Just measuring a health outcome like hypertension control and sharing the data can have an impact, said Mary Barton, a vice president at the National Committee for Quality Assurance, a nonprofit organization that creates measures commonly used to track performance, including on one hypertension.

She said the webinars likely helped health plans improve because they all received the latest information. “Across medicine you will find a lot of good intentions,” she said. “But where we fall down is everybody having the same information.”

Partnership HealthPlan of California’s chief medical officer, Robert Moore, said his organization benefited from working with other plans from across the state. “If we know many of our colleagues are working on this as well, it energizes us,” he said.

Desiree Backman, chief prevention officer for the state health care department, said improvements can be made with just a modest investment of time and resources — and with plans working collaboratively.

“It was not competitive; it wasn’t this plan against this plan,” she said. “It was really, ‘How do we as a group move these numbers in the right direction?’”

This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

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Capitol Desk Medi-Cal Public Health